title: The cost of injury and trauma care in low- and middle-income countries: a review of economic evidence.
abstract: BACKGROUND
  Injuries are a significant cause of mortality and morbidity, of which more than 90% occur in low- and middle-income countries (LMICs). Given the extent of this burden being confronted by LMICs, there is need to place injury prevention at the forefront of public health initiatives and to understand the costs associated with injury. The aim of this article is to describe the extent to which injury-related costing studies have been conducted in LMICs.
  
  
  METHODS
  A review of literature was performed to explore costing data available for injury and/or trauma care in LMICs. Study quality was described using recommendations from the Community Guide's quality assessment tool for economic evaluations.
  
  
  RESULTS
  The review identified 68 studies, of which 13 were full economic evaluations. Cost of injury varied widely with mean costs ranging from US$14 to US$17 400. In terms of injury-prevention interventions, cost per disability adjusted life year averted for injury-prevention interventions ranged from US$10.90 for speed bump installation to US$17 000 for drunk driving and breath testing campaigns in Africa. The studies varied in quality, ranging from very good to unsatisfactory.
  
  
  CONCLUSIONS
  There is a lack of injury-related economic evidence from LMICs. Current costing research has considerable variability in the costs and cost descriptions of injury and associated prevention interventions. The generalizability of these studies is limited. Yet the economic burden of injury is high, suggesting significant potential for cost savings through injury prevention. A standardized approach to economic evaluation of injury in LMICs is needed to further prioritize investing in injury prevention.
authors.affiliation: International Injury Research Unit, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD 21205, USA, Department of Surgery, Virginia Commonwealth University Medical Center, 1200 East Broad Street, Richmond, VA 23298, USA, University of Witwatersrand Faculty of Health Sciences, School of Public Health, 27 St Andrews Road, Parktown, Johannesburg 2193, Medical Reserach Council, Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, University of Witwatersrand, 7 York Road, Parktown 2193, Johannesburg, South Africa International Injury Research Unit, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD 21205, USA, Department of Surgery, Virginia Commonwealth University Medical Center, 1200 East Broad Street, Richmond, VA 23298, USA, University of Witwatersrand Faculty of Health Sciences, School of Public Health, 27 St Andrews Road, Parktown, Johannesburg 2193, Medical Reserach Council, Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, University of Witwatersrand, 7 York Road, Parktown 2193, Johannesburg, South Africa.
authors.forename: Hadley K H
authors.initials: HK
authors.lastname: Wesson
authors.affiliation: International Injury Research Unit, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD 21205, USA, Department of Surgery, Virginia Commonwealth University Medical Center, 1200 East Broad Street, Richmond, VA 23298, USA, University of Witwatersrand Faculty of Health Sciences, School of Public Health, 27 St Andrews Road, Parktown, Johannesburg 2193, Medical Reserach Council, Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, University of Witwatersrand, 7 York Road, Parktown 2193, Johannesburg, South Africa.
authors.forename: Nonkululeko
authors.initials: N
authors.lastname: Boikhutso
authors.affiliation: International Injury Research Unit, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD 21205, USA, Department of Surgery, Virginia Commonwealth University Medical Center, 1200 East Broad Street, Richmond, VA 23298, USA, University of Witwatersrand Faculty of Health Sciences, School of Public Health, 27 St Andrews Road, Parktown, Johannesburg 2193, Medical Reserach Council, Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, University of Witwatersrand, 7 York Road, Parktown 2193, Johannesburg, South Africa.
authors.forename: Abdulgafoor M
authors.initials: AM
authors.lastname: Bachani
authors.affiliation: International Injury Research Unit, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD 21205, USA, Department of Surgery, Virginia Commonwealth University Medical Center, 1200 East Broad Street, Richmond, VA 23298, USA, University of Witwatersrand Faculty of Health Sciences, School of Public Health, 27 St Andrews Road, Parktown, Johannesburg 2193, Medical Reserach Council, Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, University of Witwatersrand, 7 York Road, Parktown 2193, Johannesburg, South Africa.
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Hofman
authors.affiliation: International Injury Research Unit, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD 21205, USA, Department of Surgery, Virginia Commonwealth University Medical Center, 1200 East Broad Street, Richmond, VA 23298, USA, University of Witwatersrand Faculty of Health Sciences, School of Public Health, 27 St Andrews Road, Parktown, Johannesburg 2193, Medical Reserach Council, Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, University of Witwatersrand, 7 York Road, Parktown 2193, Johannesburg, South Africa ahyder@jhsph.edu.
authors.forename: Adnan A
authors.initials: AA
authors.lastname: Hyder
mesh_terms: D000349:Africa; D003362:Cost-Benefit Analysis; D003906:Developing Countries / Q000191:economics; D017048:Health Care Costs; D006801:Humans; D011203:Poverty; D011634:Public Health / Q000191:economics; D019057:Quality-Adjusted Life Years; D014947:Wounds and Injuries / Q000191:economics* / Q000628:therapy
keywords: Injury; costs; developing countries; economic evaluation; trauma